Epidemiological studies on the senile brain based on the histopathology are reviewed.
1) Alzheimer's neurofibrillary changes, senile plaques and granulovacuolar degenerations increase with aging. The frequency in the nineth decade and older, however, decreases. There are no close correlation between the number of Alzheimer cells and the distribution and density of the plaques.
2) The A-changes are confined almost exclusively to the median tempolar lobe. If the changes are confined to these regions, they may be considered to represent one of the physiological senile changes of the brain and the number of these cells may indicate gradation in the aging process.
3) The incidence of the plaques in the Japanese is much lower than those of most reports from the European countries and the United States. However recent studies reveal some evidence that the incidence is increasing among Japanese population.
4) Statistical studies on the granulovacuolar degenerations are too small to make geographic comparison from the pathological point of view.

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One hundred and twenty-one patients with tinnitus were analized statistically. There were no differencies between sexes, male and female. The number of patients with tinnitus were increasing with aging, and the incidence was highest in the fifth decade.
Twenty-eight of these patients had perceptive hearing impairment, 28 did not have hearing loss, 14 had combined hearing impairment and 3 had conductive hearing impairment.
The tone of tinnitus was similar to the song of cicada in 40, the chirping of insects in 45. The expression were following, kiin in 63, jiin in 37, miin in 14.
The loudness of tinnitus were as loud as causing disturbances of sleep in 1, tinnitus was present even during dailly life in 17, and it was just present during quiet midnight in 57.
Analysis of tinnitus revealed that the frequency of the tone was higher than 3, 000 Hz in 62 cases, the loudness was smaller than 5 dB in 86 ears.
The times of residual inhibition were measured, 110 ears were masked by 10 dB above sensory level of 1 minutes duration.

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Computerized tomography (CT) scans of 72 patients with severe head injury were reviewed and the findings were compared with the prognosis. In this study, CT scan was performed within 24 hours after the accident in all cases. Approximately half of the patients showed poor prognosis.
Findings on CT were classified into 5 types: cerebral contusion (type 1), intracranial hematoma (type 2), cerebral contusion with intracranial hematoma (type 3), subarachnoid hemorrhage (type 4), and posterior fossa hematoma (type 5). In the present study 70% of patients had type 1 or type 2. The prognosis of both type 1 and type 3 was poor.
Findings on ambient and guadrigeminal cistern (AQC) have a close correlation with the outcomes. The patients, whose AQC disappeared, showed the worst outcomes. However, the patients with type 5 showed good outcomes inspite of disappeared AQC.

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1) Rorschach test was performed in 125 normal individuals and 38 schizophrenic inpatients. The factors possibly influencing pathological features of the schizophrenics by aging were analized.
2) The items which have correlations (a) with both aging and mental decline were FC· ∑C·c'·CR·DR (↓) Rej·F% (↑), (b) with mental decline were W%·FM (↓)·D%(↑), and (c) with aging were R·P (↓), while the scores maintained the same levels as in the adults were M·H% and R+% (→). It was suggested that the normal elderly, in spite of the restriction of the adaptability, keep holding the inner stability and the means to adjust themselves to the social community life.
3) The scores in the elderly schizophrenic inpatients' group showed basically similar tendencies to the younger age group, though poorer than the other. The differences between two groups seemed to become smaller than in the younger populations. Maintenanece of M·P·F+%, and R+%, with the decrease of S% might reflect the trend of the old schizophrenics which is favourable to the readaptation to the social life.

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The status of marriage was investigated among seventy-eight schizophrenics who had married before the onset of the illness. The results were as follows:
1. The age of onset in many male and female patients was in their thirties. Majority of patients were ill with schizophrenia for a period of more than several years after marriage.
2. The number of patients who had divorced were four (12.5%) in males, twenty-three (50%) in females. The onset or relapse of the disease was the most common cause for divorces.
3. The family members are usually husband and wife, but in female patients there were some who lived with their parents, or lived alone.
4. Social adjustment was good in both male and female patients, but the state of employment in female patients was better than in male ones. Social adjustment of patients without their partners was slightly worse than that of patients who continued their marriages.

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[in Japanese]

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A retrospective studies, as to pathological findings during the last forty years were performed. The following results were obtained.
1) The average age of death was 61 years and the duration of illness was about 9 years in the last ten years.
2) In 71.7% of patients, death was related to tuberculous, such as chronic cardiopulmonary failure (56.6%), hemoptysis (8.5%), aggravation (6, 6%). In the remaing 28.3%, death was caused by mainly non-tuberculous diseases, such as cancer, apoplexy, cardiac disease.
3) The main pathological changes in the lung were characterized by the sclerotic type and cavitary type.
4) The average weight of the heart was remarkably decreasing (cor pulmonale).
5) Based on the above findings, we concluded that the clinical courses and the direct causes of death have been markedly changing in accordance with the use of antituberculous drugs, in contrast to that of the old tuberculosis.

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Clinical studies on pulmonary tuberculosis were done and the following results were obtained.
I. Changes of tuberculosis at Kumamoto-Minami Byoin National Sanatorium during 6 years from 1976 to 1981
(1) The number of newly admitted patients with tuberculosis was 579 (male 447, female 132).
(2) The average length of hospitalization was 16.2 months in 1976, but became shorter to 5.8 months in 1981 by initial intensive chemotherapy.
(3) One hundred and fifty-four (50.7%) out of 304 cases had positive sputum culture for tubercle bacilli before treatment.
(4) Clinical effects of initial intensive chemotherapy for pulmonary tuberculosis was as follows; sputum culture became negative in 96.4% (148 out of 154) and 86.1% (262 out of 304) showed improvement of X-ray findings at the end of chemotherapy.
(5) Undoubtedly complications including 34 cases of diabetes mellitus, 15 cases of hepatic diseases, 18 cases of silicosis and 10 cases of cancer had a general tendency to have unfavourable effect on the course of pulmonary tuberculosis.
II. Bronchial tuberculosis
During the last five years we experienced 9 cases of bronchial tuberculosis. Of these, 5 cases were right-sided, and 4 were left-sided. All 9 cases were female. These results suggest that bronchial tuberculosis is not rare even nowadays despite the decreasing pulmonary tuberculosis. In those cases with long-standing respiratory symptoms, even in the cases whose chest X-ray films show no or minimal abnormalities, bronchial tuberculosis might be taken into account, careful examination of sputum and bronchoscopic examination should be actively done to confirm the diagnosis and for the determination of accurate lesion.
III. Quantitative diagnosis of coin lesion on the basis of quantification theory
(1) A total of 61 cases with solitary coin lesion of known etiology was statistically analysed.
(2) Of these 61 cases, 26 casess were benign and 35 cases were malignant.
(3) Lobulation, notch and poor delination of the mass are more common in malignant lesions and satellite lesions, cavity formation and calcification are common in benign lesions.
(4) Two groups, either benign or malignant, were significantly divided by Hayashi's quantification analysis with correlative coefficient of 0.7171.
(5) On the basis of cumulative frequency by calculation of these factors by giving category score on each factor, malignant lesions could be determined by the probability of 94.3% with 7.7% error in which benign cases could be included.

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Main cause, incidence and clinical findings of pulmonary tuberculosis derived from compromised host, that is, severely ill or terminal patient whose vital resistance of the body has markedly reduced, were studied in detail.
Among 3782 patients with pulmonary tuberculosis discharged from our hospital during the past six years, only 1110 cases (29.3%) have complications.
Twenty-eight cases (2.5%) out of these 1110 patients were considered to have pulmonary tuberculosis under the condition of compromised host.
The underlying diseases of the 28 cases were mainly classified into six diseases, malignant tumor (post operative), liver diseases, bronchial asthma, chronic rheumatoid arthritis, renal insufficiency and diseases of bone and joint, and moreover administration of adrenocortical steroid hormon was found in eleven cases.
Onset of these cases takes acute form, but its prognosis is comparatively favorable for the course of pulmonary tuberculosis by adequate antituberculous chemotherapy.
As for the diagnosis of pulmonary tuberculosis derived from compromised host, high percentage of the cases is diagnosed incorrectly, therefore, careful examination for differential diagnosis is usually required in patients with terminal stage of generalized diseases.

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During ten year interval from 1972 to 1981, 267 patients underwent thoracotomy for pulmonary tuberculosis or empyema at Seiranso Byoin National Sanatorium. Although there were 48 patients who required thoracotomy in 1973, only 15 patients were operated in 1981.
In recent years, the diagnosis of tuberculosis was made at surgery in one third of patients who underwent thoracotomy with preoperative diagnosis of lung cancer.
Although the advent of effective antituberculous agents has decreased the numbers of patients who need operation, it is also true that patients in whom operation is really necessary do exist.
From our experiences during these ten years, following comments can be made on interesting cases.
1) Bronchial tuberculosis: Six patients underwent thoracotomy. Five patients were female and one was male. Four patients underwent left upper lobectomy along with circumferential excision of the left main bronchus. In these cases it was possible to preserve pulmonary function of left lower lobe by performing bronchoplasty. Right middle lobectomy and pneumonectomy of the right side were performed in one patient respectively. In the latter case with tuberculous stricture of the right main bronchus, preservation of middle and lower lobe could have been possible if operation was performed one year early. From this experience we learned that we should not lose the timing of operation.
2) Empyema: Generally, if it occurs, bronchial fistula after pulmonary resection is seen from one to several weeks postoperatively. Bronchial fistula and empyema were seen in two patients after 17 years and in one patient after 22 years postoperatively. Result of surgery in these patients was excellent. A long time follow-up is necessary in patients undergoing pulmonary resection for tuberclosis.
3) Cases with positive smear and negative culture for tuberculous bacilli (abbreviated as SPCN): In one patient with SPCN for two years underwent right upper lobectomy. Although smear of resected specimen was reported to be positive for tuberculous bacilli (Gaffkey 8), only one of three cultures was positive.
In patients with long lasting SPCN for tuberculous bacilli, it should be considered that tuberculous lesion is more active than we have expected and surgical intervention should be considered.
4) Cases in which timing of operation was lost. In several patients who had been undergone pulmonary resection of contralateral side, we hesitated to perform operation and lost the good timing of operation. Three patients died of progression of tuberculosis. We realized that in patients with recurrent pulmonary tuberculosis, surgical intervention should be considered.

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A total of 10, 498 patients was admitted to the ward for pulmonary tuberculosis of our hospital between 1963 and 1981 and 196 (1.87%) of these patients developed pulmonary infectious diseases due to atypical mycobacteria. The number of newly found patients per year increased initially in 1968 remained on the same level for the following ten years and increased again in 1978 (Table 1).
Most of the patients with pulmonary infectious diseases between 1963 and 1977 developed M. avium-M. intracellulara disease, although a small number of patients with M. scrofulaceum disease was observed.
In 1978, M. kansasii disease was found for the first time and then, the number of patients with this disease has increased. Around the same time, infectious diseases due to uncommon kinds of species, that is, M. szulgai, M. nonchrornogenicum, M. fortuitum, M. chelonei subsp. chelonei and M. chelonei subsp. abscesses, began to appear (Table 2).
Causative organisms in these 196 patients with pulmonary infectious diseases due to atypical mycobacteria were M. intercellulare (83.2%), M. kansassi (10.7%), M. scrofulaceum (2%), M. nonchromogenicum (2%), M. szulgai (0.5%), M. fortnitum (0.5%), M. chelonei subsp. chelonei (0.5%) and M. chelonei subsp. abscesses (0.5%) (Table 3).
On the basis of the above results, the movement of pulmonary infectious diseases due to atypical mycobacteria in Japan was investigated epidemiologically and ecologically. In summary, in the first stage, the diseases were found as uncommon infectious diseases for a certain period, in the second stage, the number of the diseases developed in a certain area increased and in the third stage, the number of patients with the diseases increased in extended areas. It is considered that such phenomena are caused by a decrease in the number of patients with pulmonary tuberculosis and an incerease in the number of the elderly from the viewpoint of the host (human) and by adaptation to the circumstances and an increased number of opportunities to approaching or encountering with human beings from the viewpoint of causative organisms.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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The patient was 39 year old male with aplastic anemia. He was given fluoxymesterone for 3 years. Hematological findings initially improved markedly, but aggravated after a year of the discontinuation of the drug. The patient died of cerebral bleeding in spite of re-administration of fluoxymesterone. The autopsy revealed many small scattered cyst-like spaces filled with blood in the liver, i. e. peliosis hepatis.
Most cases reported in the literature were cases dying of massive tuberculosis and cancer. The present case of peliosis hepatis developed after administration of androgenic and anabolic hormone. However, reports of this lesion are very rare in Japan.

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The case is a 42-year-old man who had high fever and headache. At first, typhoid fever or meningitis was suspected. Since he had kept shell parrakeets and one of them died, psittacosis-lymphogranuloma group was suspected. He was diagnosed as having psittacosis-lymphogranuloma group by a blood test.
This is a disease which has attracted attention as an imported infection, but there are not many typical cases. Antibiotics including cephalosporins are used frequently in cases suspected of this infection.
Presumably this is one of the factors which makes this disease atypical and precludes a reliable diagnosis.

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A 29-year-old man with rupture of valsalva sinus aneurysm into the outflow traot of the right ventricle, died of severe hepatic insufficiency displaying significant jaundice and hypoglycemia inspite of vigorous treatment for biventricular heart failure.
We referred to the literatures on the cases of severe heart failure causing the severe hepatic failure displaying significant jaundice and hypoglycemia.
It is our conclusion that in the case of Valsalva sinus aneurysm ruptured into the rightsided heart chambers, operation must be performed as soon as possible once the diagnosis was made, because in these cases, the ordinary treatment of heart failure such as rest, the administration of cardiac glycosides and diuretics can even make hepatic function worse.

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The number of newly-detected leprosy patients are investigated in Hirara city, Gusu-kube-cho, Ueno-cho, Shimochi-cho, Irabu-cho and Tarama village in Miyako Islands for fifty years.
In Miyako Islands leprosy segregation policy was taken place by local government in 1931 and leprosy out-patient department was established in Hirara city by “Okinawa Antileprosy Association” in 1968 In 1967 Laprosy School Survey has been done in the islands by Japanese Government.
According to the collected data on new patients in the islands by each year, the most highest rate of the incidence of leprosy was 0.67 per population of 1, 000 in 1967 and the rate came down to 0.02 in 1983
Also no children case develop leprosy since 1978.
The situation of leprosy in the islands has been improved remarkably after the treatment of out-patients with leprosy started there.
The only problem of leprosy control is that the decrease in number of new patients in Hirara city is somewhat slower than other areas, because of “Urban Leprosy”. The programs for leprosy control should be more emphasized in the urban area of the islands.

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The relationship between life satisfaction index A (US-A) and Cornell medical index (CMI) and Self-rating quetionnaire for depression (SRQD) are analyzed.
Based on data from 50 patients of Kanazawa-Wakamatsu Byoin National Sanatorium, LIS-A scores were negatively paralleled with the grade of CMI and SRQD scores.

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